肝移植术后耐万古霉素肠球菌感染的病原学特点和耐药性分析

doi:10.3969/j.issn.1005-6483.2021.11.008

摘要/Abstract

摘要： 目的探讨肝移植术后耐万古霉素肠球菌感染的病原学和耐药性特点。
方法回顾性分析我科2015年1月~2019年12月524例同种异体肝移植病人的临床资料，分析其术后发生耐万古霉素肠球菌感染的发病率、病原学特点、分布情况和耐药性特点。
结果 524例肝移植病人中共109例病人术后发生腹腔感染，发病率为20.80%(109/524),其中肠球菌感染46例，全为屎肠球菌；肠球菌感染发病率为8.78%(46/524)，肠球菌感染占腹腔感染病人的42.2%(46/109)，占革兰阳性球菌感染的64.79%(46/71)；46例病人中15例为耐万古霉素肠球菌感染，万古霉素耐药率为32.61%(15/46)；药敏结果显示，耐万古霉素肠球菌对青霉素、氨苄西林、环丙沙星、左旋氧氟沙星及红霉素类抗生素完全耐药；对四环素类、高浓度链霉素、高浓度庆大霉素等抗生素也广泛耐药，耐药率分别为71.43%(15/21)、85.71%(18/21)和71.43%(15/21)；对替考拉宁耐药率为38.10%(8/21)；对利奈唑胺亦出现耐药株，耐药率为9.52%(2/21)；替加环素最为敏感，尚未检出耐药菌。
结论耐万古霉素肠球菌是肝移植病人术后常见的病原菌之一。常规预防性抗生素对耐万古霉素肠球菌治疗无效，临床上可根据药敏结果选择抗生素，替加环素和利奈唑胺可作为治疗的首选。

关键词: 肝移植, 耐万古霉素肠球菌, 耐药性

Abstract: Objective In order to investigate the etiology and drug resistance of vancomycin resistant enterococci after liver transplantation.
Methods We retrospectively analyzed the clinical data of 524 consecutive patients who underwent liver transplantation in Beijing Chaoyang Hospital in January 2015-2019 in December.Incidence rate and etiology of vancomycin resistant enterococci infection after operation were analyzed.Distribution and drug resistance.
Results 109 of the 524 patients underwent abdominal infection after operation,the incidence rate was 20.80%(109/524).Enterococcus infection was 46 cases,all enterococcus faecium,enterococcal infection rate was 8.78%(46/524),enterococcal infection accounted for 42.2%(46/109) of the patients with abdominal infection,accounting for 64.79%(46/71) of gram positive cocci infection,15 cases of vancomycin resistant hair coloring and 15 vancomycin resistance rate of 32.61%(15/46),and drug sensitivity test showed
vancomycin resistant enterococcus was completely resistant to penicillin, ampicillin, ciprofloxacin, levofloxacin and erythromycin antibiotics;it was also widely resistant to tetracycline, streptomycin, gentamicin and other antibiotics;and the drug resistance rates were 71.43%(15/21),85.71%(18/21),71.43%(15/21),38.10%(8/21) to teicoplanin,and resistant strains to linezolid,the drug resistance rate was 9.52%(2/21).Tecycline is the most sensitive and no resistant bacteria have been detected.
Conclusion Vancomycin resistant Enterococcus is one of the common pathogens in liver transplantation patients.Conventional prophylactic antibiotics are ineffective in the treatment of vancomycin resistant enterococci,and tigecycline and linezolid can be the first choice for the treatment.

Key words: liver transplantation, vancomycin resistant enterococcus, drug resistance

任章勇吕少诚曹迪王芳菲赵昕贺强. 肝移植术后耐万古霉素肠球菌感染的病原学特点和耐药性分析[J]. 临床外科杂志, 2021, 29(11): 1025-1028.

REN Zhangyong, LV Shaocheng, CAO Di, et al.. Pathogenic characteristics and drug resistance of vancomycin resistant enterococci after liver transplantation[J]. JOURNAL OF CLINICAL SURGERY, 2021, 29(11): 1025-1028.

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